Penn Heart and Vascular

Getting Out of AFib Forever: Mike's Story

"From now on, I'm going to Penn."

When Mike Dennis called Penn Medicine, he had already been in atrial fibrillation for a month.

"My heart had been beating between 150 and 180 beats per minute for weeks," says Mike. "I was in congestive heart failure, too. My ejection fraction had steadily dropped from 35 percent to around 10." Ejection fraction is a measure of blood being pumped by the heart. Healthy hearts pump between 55 to 70 percent.

It had all started on Labor Day weekend. When Mike first felt symptoms of atrial fibrillation—an irregular heart beat in the form of a rapid fluttering of the heart's upper chambers— his wife drove him to a local hospital. Mike then spent 20 of the next 30 days at the hospital as doctors struggled to find a treatment.

"I was treated with so many medications," says Mike, "But my doctors there remained confident they would get me back on track."

When they were unable to make any progress, Mike was sent to a larger regional hospital. Six days later, Mike was discharged. He had been implanted with an implantable cardioverter-defibrillator (ICD)—but he was still in atrial fibrillation.

"We'll get you out of A-fib."

Mike decided to make a call to the Penn Medicine cardiac arrhythmia program.

"I asked how low an ejection fraction could go," recalls Mike. "The program administrator said, 'Oh, it can go way down. We've had people who were up and talking at 15 to 20.' When I told her mine was 10, she said, 'Can you come in on Tuesday?'" Mike was scheduled for an appointment with Mathew Hutchinson, MD, a Penn cardiac electrophysiologist.

At his appointment, Mike explained all of the difficulties he had been having due to his abnormal heartbeat. When Dr. Hutchinson plainly stated they needed to get Mike out of A-fib, Mike replied his doctors had been trying to do that for a month.

"He just smiled." says Mike. "Dr. Hutchinson said, 'We'll get you out of A-fib. That's no problem.'"

Dr. Hutchinson explained that Mike needed to be cardioverted, a process that shocks a heart back into a regular rhythm.

"I asked him how soon we could do that," says Mike. "And he looked at his watch."
The procedure was performed the very next day. Mike's heart returned to its regular rhythm, and he was placed on medications to help keep his heart out of A-fib.

Mike and his wife, Cathy, at their home in New Jersey.

Fixing bad connections

The medications kept Mike's heart beating regularly. At a follow-up visit, though, Dr. Hutchinson wanted to discuss the implications of continuing the drug therapy.

"He told me that, while this drug is highly effective, it can also cause lung problems and liver failure," says Mike. "He explained there was an alternative: going inside the heart and getting rid of the bad electrical connections that were causing all my problems."

The approach that Dr. Hutchinson discussed with Mike was an atrial fibrillation ablation. In this procedure, tiny catheters are threaded through small incisions in the skin until they reach inside the heart. The electrical connections of the heart are then methodically tested. Irritable sites that cause A-fib are effectively walled off or ablated to keep them from disrupting the rhythm of the heart.

Mike decided to have the ablation. During the procedure, Dr. Hutchinson found many trouble spots in Mike's heart, which helped explain why his A-fib had been so hard to control.

The next day, Mike went home.

Beating A-fib permanently

For the next eight months, Mike's heart had a normal rhythm—without any need for medication. Then he started noticing problems.

"I would feel a little blip here or there," Mike says. "I asked Dr. Hutchinson, 'What do we do now?'"

Because of the severity of Mike's previous condition, the ablation procedure had eliminated most of the electrical problems in his heart, but not all of them. So his choices were simple: He could go back on the medication, or he could have another ablation.

Mike chose the ablation, which was performed in May of 2009. In a letter he then wrote to the hospital, he described the results as "spectacular" and "awe-inspiring".

"Here's the good news," says Mike. "I have not had a blip of atrial fibrillation since then."

He adds: "From now on, I'm going to Penn."